Psychomotor agitation in major depressive disorder is a predictive factor of mood-switching

• Published in: Journal of affective disorders 2015-01, Vol.170, p.185-189
• Main Authors: Iwanami, Takao, Maeshima, Hitoshi, Baba, Hajime, Satomura, Emi, Namekawa, Yuki, Shimano, Takahisa, Suzuki, Toshihito, Arai, Heii
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - complications; Bipolar Disorder - psychology; Bipolar disorders; Bipolarity; Depression; Depressive Disorder, Major - complications; Depressive Disorder, Major - psychology; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Major depressive disorder; Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Mood Disorders - complications; Mood Disorders - psychology; Mood-switching; Predictive Value of Tests; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychomotor agitation; Psychomotor Agitation - complications; Psychomotor Agitation - psychology; Psychopathology. Psychiatry; Survival Analysis; Young Adult
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2014.09.001

Abstract Background The relationship between psychomotor agitation in unipolar depression and mood-switching from depression to manic, hypomanic and mixed states has been controversial. We investigated the future risk of initial mood-switching as a function of psychomotor agitation in unipolar depression. Methods We identified 189 participants diagnosed with major depressive disorder (MDD). We divided all patients with MDD into two categories (1) agitated patients ( n =74), and (2) non-agitated patients ( n =115). These groups were prospectively followed and compared by time to mood-switching. Kaplan–Meier survival curves, log-rank test for trend for survivor functions, and Cox proportional hazard ratio estimates for a multivariate model were conducted to examine the risk of mood-switching by psychomotor agitation. Results During follow-up, mood-switching occurred in 20.3% of the agitated patients and 7.0% of the non-agitated patients. In the Kaplan–Meier survival estimates for time to incidence of mood-switching with agitated or non-agitated patients, the cumulative probability of developing mood-switching for agitated patients was higher than those for non-agitated patients (log-rank test: χ2 =7.148, df=1, p =0.008). Survival analysis was also performed using Cox proportional hazards regression within a multivariate model. The agitation remained significantly associated with incidence of mood-switching (HR=2.98, 95% CI: 1.18–7.51). Limitations We did not make a clear distinction between antidepressant-induced mood-switching and spontaneous switching. Conclusions The main finding demonstrated that MDD patients with agitation were nearly threefold as likely to experience mood-switching, suggesting that psychomotor agitation in MDD may be related to an indicator of bipolarity.